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Organization Application
STEP ONE
Name
Year organization incorporated:
Address (include street address if different)
EIN#:
Is the name above the same as it appears on the IRS Letter of Determination?
yes
no
If not, please explain:
Chief Executive Name & Title:
Contact Name & Title:
Phone Number:
Fax Number:
Email:
ORGANIZATIONAL DEMOGRAPHICS
Number of part time staff:
Number of volunteers:
Geographic Area
OPERATING BUDGET FOR FISCAL YEAR:
Fiscal Year, from:
Fiscal Year, to:
Submit Step One
After you submit Step One, please continue with Step Two to finish your application.
STEP TWO
Organization Name
SOURCES OF INCOME
% Federal
% State
% County
% City
% Fees/Earned Income
% Individual Contributions
% United Way
% Workplace Campaigns (not United Way)
% Corpoerate and/or Foundation Grants
% Special Events
% Memberships
% Other
Amount of this request:
Funds need by:
Time frame in which funds will be used:
From:
To:
Choose:
General Operating Support
Project Support
If for support, complete the following:
Project Name:
Total Project Cost:
Percent this request is of project total:
Project Type:
Capital Construction
Capital Renovation
Capital Equipment
Endowment
Specific Program
Other (describe below)
If other, describe:
Who will project serve:
How many will project serve:
What geographic area will project serve:
FOUNDATION REQUESTS
THE FOUNDATION REQUESTS THAT YOU LIMIT THE LENGTH OF YOUR ANSWERS FOR THE FOLLOWING QUESTIONS TO NO MORE THAN A TOTAL OF FOUR PAGES.
1. APPLICANT ORGANIZATIONAL BACKGROUND
Include organizational mission statement and purpose, organizational qualifications, history of accomplishments, governance, area and population served, role or volunteers. (If this is collaboration, describe the lead agency and its relation to others involved.)
2. NEEDS STATEMENT
Identify the needs your agency, or this proposal will address. Acknowledge similar existing projects or agencies, if any, and explain how your agency or proposal differs, and what effort will be made to work cooperatively.
3. PROPOSAL
A. How will your proposal address identified needs?
B. Projected goals, objectives, timeline, anticipated impact.
C. Expected role of volunteers.
D. Number and types of people who will benefit from your proposal.
E. How will you monitor your work and how will you measure success or effectiveness?
F. What are your other potential and actual sources of support for this proposal? Where do you expect to find future support?
4. APPROPRIATENESS TO FOUNDATION’S MISSION
Explain how your project or program furthers the goals of The Janice Seagraves Family Foundation.*
5. ADDITIONAL INFORMATION
Please address here anything else about your organization or project you think is relevant to this proposal.
Upload Document here:
Submit Step Two
